2014, 03-12 Permit App: BLD-2014-0468 DemolitionSpokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevallev.orci
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
DEMOLITION PERMIT APPLICATION
PROJECT ADDRESS: /4/7 4/, es
ASSESSORS PARCEL NO.:
BUILDING OWNER NAME: vv ' //jam
MAILING ADDRESS: , `/ /3 c /( 486'
CITY: !r'' ,V e4' T/ `(,-4-"''
' _ STATE: l ZIP: ri / �% ' G`fcJ
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CONTACT PERSON NAME:J �� ��/����
PHONE:/71 / FAX: CELL: 70 d ' 4)60-0b''cj Z...
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CONTRACTOR NAME: ('<),v,"/"�/4/ // J4'
LL ,/,SX ic,'S 7N.
MAILING ADDRESSES: & 370 5 644/ '_4 -tom.
CITY: �' �r'S 1 /')L� `r STATE: _..lit.! t1 A) ZIP: 3;73,SJ
CELL: G "J -6,41- 5/6-4 Z
PHONE: LCed. ` 765 6 -pyi
CONTRACTORJ� LICENSE No.: 115 4/07
FAX: 20 S— 76S_
EXPIRES: - 14
CITY BUSINESS LICENSE NO.:
PROJECT DESCRIPTION (Please Provide Site Sketch)
ISit Site Plan Provided ❑ Notice of Intent #
El Spokane County Utilities has approved the disconnection
Describe the scope of work in detail
bow, C) / ( -21%C)1..L /gSenv 14
DISCLAIMER
The
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitteand subsequently approved before this application can be processed.
Project ,46C -Pt --)0W-01-16$
- RECEIVED
MAR 12 2014
CSY PERMIT CENTER
SUB Is -El: REV.
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Demolition_ Permit_1-11-11.doc
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Project # 5C-0 -ED-OP-t:_-__O 4:2
RECEIVED
APR 15 2014
CSV PERMIT CENTER
SUB #
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Spokane Regional Clean Air Agency https://www.spokanecleanair.org/asbestos/e-noi/history/4268/print
Spokane r11
L,Lea n AlrAgency
Asbestos E-NOI (submit, pay online)
Back
E-NOI #2014-0127
Title
Price
Demolition
$250.00
$250.00 paid on 3/31/2014 10:37 am
Property Information
Fire Damaged: No
Owner: Williams Withers
Phone: 208-660-0892
Fax:
Address: P.O. Box 488
Liberty Lake, WA 99019
Contact Name: Jerry Kuisti
Job Phone: 208-660-0892
Structures
1. 1417 N Hodges RD
» Demolition Only
Asbestos Information
Material Presumed: No
Inspector Name: Samuel Bailey JR
Survey Company: Mountain Consultanting Services LLC
Certificate Number: BIR -13-038
Survey Date: 3/19/2014
Asbestos Identified: Yes
Disturbed/Non-Intact: No
Asbestos Removal: Yes
Nonfriable Removal: Yes
Start Date: 4/10/2014
pro.ect..,::
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RECEIVED
\PR , 5 2014 14H
CSV [:rp"; -
1 of 2 3/31/2014 10:38 AM
ipokane Regional Clean Air Agency https://www.spokanecleanair.org/asbestos/e-noi/h>istory/4268/print
Complete Date: 4/11/2014
Contactor: Summit Environmental
Job Number: 14-046.1
Contact: Mike Stroh
Phone: 208-665-7060
Address: P.O. Box 3600
Post Falls, ID 83877
Demolition Information
Start Date: 4/11/2014
Contactor: Cannon Hill
Job Number: 14-046.1
Contact: John
Phone: 208-765-6794
Address: 5605 Seltice Way
Post Falls, ID 83854
of 2
3/31/2014 10:38 AM
Mountain Consulting Services, LLC
9922 East Montgomery Drive, Suite 9
Spokane Valley, WA 99206
509-924-9236
509-924-2287
March 26, 2014
Mr. William Withers
Post Office Box 488
Liberty Lake, WA 99019
Project No: 14-046.1
Dear Mr. Withers:
Mountain Consulting Services, LLC (Mountain Consulting) is pleased to provide this summary
of findings for the Pre -Demolition Asbestos Survey conducted for the suspect building
materials present with the 14'x 72' Mobile Home Structure located at 1417 North Hodges Road
in Spokane Valley, Washington 99016. It should be noted that the detached pole barn style
shop -garage structure was not included with survey activities.
Mr. Samuel W. Bailey Jr., EPA -accredited AHERA building inspector, certification BIR -13-038
expiration 10-8-2014 conducted a field survey of the residence on March 19th of 2014.
The following sampled building material collected from the Mobile Home Structure was found
to contain greater than one percent (>1 %) asbestos by laboratory analysis (Regulated ACM):
• Tannish -Grey Colored Construction Caulking Sealant present located between window
frame & door frame to structure sidewall joints around the exterior of the structure was
found to contain asbestos. This class II, non -friable, miscellaneous material contains 5-8%
Chrysotile Asbestos. There is approximately 210 linear feet (If) of this material present
with 14 exterior window units and 2 exterior entry door units. Represented by Bulk
Samples 14-046.1-11 & 12.
The following sampled suspect building materials associated with the Mobile Home Structure
were proven to be asbestos -free by laboratory analysis (ACM -Free):
• Orange & Yellow Vinyl Sheet Flooring (VSF) & Tan Mastic (sample 01)
• Off White & Brown Fiberboard Ceiling Panels (sample 02)
• Black & Tan Backing Paper (of fiberglass bat ceiling insulation) (sample 03)
• Black Thin -set Grout & Adhesive (of living room fireplace, faux brick) (sample 04)
• Sheetrock (backing of living room fireplace, faux brick, no J/C) (sample 05)
• Black & Tan Backing Paper (of fiberglass bat walls insulation) (sample 06)
• White Formica & Gold Adhesive (of kitchen & bathroom countertops) (sample 07)
• Orange & Yellow VSF & Brown Mastic (of bathroom tub -surrounds) (sample 08)
• Grey & Brown Exterior Fiberboard Wall Paneling (looks like T-111 siding) (sample 09)
1
1417 N. Hodges Road
3/26/14
Page 2
• Clear -Grey Caulking (of exterior siding wall joints) (sample 10)
• Grey Concrete (of trailer anchoring mounting pads) (sample 13)
• Grey & Tan Thick Paper Paneling (underside of trailer) (sample 14)
• Brown & Black Asphalt Shingle Roofing (ASR) (exposed roofing layer) (sample 15)
• Black Tar Tack Strips (underside of brown & black ASR) (sub -sample 15-A)
• White & Black ASR (2nd roofing layer) (sample 16)
• Grey, Black & Off White ASR (3rd roofing layer) (sample 17)
• Black Tarpaper (4th roofing layer) (sample 18)
• Sheetrock (walls lining of hot water tank small room area, no J/C) (sample 19)
No other suspect building materials associated with the Mobile Home Structure were identified
to be tested for asbestos content. This letter is a summary of services provided and results of the
analysis that will be described in the complete survey report. Please read the full report for
further relevant details of the investigation.
If you have any questions about this summary, please call me at (509) 924-9236. It was a
pleasure working with you, and we look forward to working with you again.
Sincerely,
Mo Consulting Services, LLC
v \ Li
Sa *el W. Baily Jr.
Operations Manager
sbailey@mountainconsultingllc.com
WASTE M ..GEMENT
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• RECEIVED
APR 1 5 201ii
CSV PERMIT CENTER
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SUB ;,-- '44REV, --=
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R; CERTIFIES NON-PS8ESTOE, OEERTS/EXC:EPT:PROEPX1-16ED- 4/WP
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except as noted in item 12.
Printed/Typed Name and Title:
Signature:
ar—te-•-i0
( -3 CC (VP444-6ive--
Date: 421
GRAHAM ROAD RECYCLING AND DISPOSAL FACILITY
1820 South Graham Road * Medical Lake WA 99022 * 509-244-0151 * Fax: 509-244-0207
WASTE SHIPMENT RECORD
1. Work Site Name and Mailing Address: 1417 N Hodges Rd Spokane Valley, WA 99106
2. WORKSITE NAME/ADDRESS : 1417 N Hodges Rd Spokane Valley WA 99106
3. Owner's Name: Williams Withers
4. Mailing Address/Zip Code: P.O. Box 488 Liberty Lake, WA 99019
County: Spokane Phone Number: 208-660-0892
5. Operator's Name and Address:
Name: Summit Environmental, Inc
Address: P.O. Box 3600 Post Falls, ID 83877 Phone Number: 208*765*3595
6. Disposal Site Name: Waste Management - Graham Road Recycling and Disposal
Mailing Address: 1820 South Graham Road, Medical Lake WA 99022
Site Address: 1820 S. Graham Road, Medical Lake WA 99022 Phone Number: 509-244-0151
7. Name and Address of Responsible Agency:
Spokane Regional Clean Air Agency,
3104 E. Augusta Ave., Spokane, WA 99207 Phone Number: 509-477-4727
8. Description of Materials: 6. Containers: 7. Total Quantity in cubic Yards:
•
Vti , ✓IG Cr AA)? Number: Type:
LI ;, Molok/5 `/ noLC%5 R. 06u -hie 13,.,c-eof / Fb
i,
8. Special handling instructions and additional information:
Operator's Certification: I hereby certify that the above listed material(s) is (are) not hazardous waste as defined by
40 CFR Part 261 or any applicable state law. I hereby declare that the contents of this consignment are full and
accurately described above by proper shipping name and are classified, packed, marked and labeled and are in all
respects in proper condition for transport by highway according to applicable international and government regulations.
Printed/Typed Nam and Ti . _Tec 5,.,,�,. .tWcr' 5 L; f eV '; 5UV�
Signature:id/ " t.,. /l--- Date:
10. Transporter 1 (Acknowledgement of receipt of materials)
Printed/Typed Name & Title: Summit Environmental, Inc. (.e f1,- ev ) su peri, , 54714/
Address: P.O. B(4600 P IIs ID 83877 Phone Number: 208-665-7060
Signature:
11. Transporter"( cknowledgementreceipt of materials)
s)
Printed/Typed Name & Title:
Address: Phone Number:
Signature:
12. Discrepancy Indication Space:
13. Disposal Site Owner/Operator: Certification of receipt of asbestos materials covered by this manifest
except as noted in item 12. 6
Printed/Typed Name and Title: `` // U GG (('B'�
Signature: \i���w�
(-3 CCC VA'h4-6+ve-- Date: /1 L it GT